If you are (or ever have been) a gymnast, a tumbler, or a basketball player/volleyball player - you've likely had an ankle taped/braced or seen a teammate who has. This is relatively common practice in any sport where the risk of ankle injuries (specifically inversion ankle sprains) is high.
I've coached gymnastics/acrobatics for almost 20 years and have been a participant/performer for far more. Ankle injuries suck - I know, I've had several. After bilateral recurring ankle injuries, I was a naive 18-year-old competitive gymnast that wanted to stop rehabbing and get back to practicing and competing. So, I did what most of us do - I started taping my ankles for every practice and competition. I no longer feared taking landings as the braces made my ankles "invincible." I was back in the gym and after all - that's what I wanted most.
I was so happy in fact, that I didn't notice the decline in my performance. I failed to recognize that my tumbling stopped progressing, my vaulting power seemed to plateau and I was beginning to have more soreness in my knees. My landings always came up "a little short" and my low back was less willing to bend for that back-walkover on the high beam. I, like my coach, chalked it up to the "time away from training" while my ankles were injured the year prior.
My "ignorance is bliss" stint lasted one year. I was pulled out of it when I experienced what many gymnasts do after bracing their ankles - a serious and career-halting knee injury.
Fast forward 15 years. In that time I've gotten a doctorate in physical therapy, treated hundreds of patients and coached college-level gymnastics and acrobatics for over a decade. While the research hasn't been done to verify the correlation between ankle bracing and knee injuries in gymnastics, my experience has shown me that there is a connection. Beyond that, it seems that time and again, ankles are taped/braced far longer than they should be - and often for the wrong reasons.
Before you blindly trust my professional opinion, a summary of the current research might be beneficial...
Most research on the injury risk associated with taping/bracing ankles has been done to verify that if you support the ankle joint, the risk of ankle injury goes down. What's less research in the literature are the effects wearing brace/tape on the ankles can have on an athlete’s knees, hips and low back. Here are the studies that have undertaken the task so far:
- One study performed at the University of Utah noted that ankle taping/bracing decreased vertical jump height and broad jump distance, as well as caused a small decrease in sprint speed.
- Another study, published in 2014 found that taping the ankle changed the amount of hip extension available during running, noting that over the course of a 20-minute run, the average participant lost "just" 3 degrees of hip extension during the push off of the run.
- Relative to changes in biomechanics, a study by Kandy Venesky at Indiana University showed that wearing ankle braces increased the twisting forces about the knee by 10%, increasing the potential for knee ligament injuries.
- Another study, published in 2010, confirmed this increase in valgus (twisting) force and suggested that despite the improved safety at the ankle joint, there was an increased possibility of anterior and medical cruciate ligament tears (the two most commonly injured ligaments in gymnasts).
- Research from The University of Kansas Medical Center concurred with these findings on knee valgus, showing that wearing ankle braces significantly increased torque at the knee joint during trunk rotation movement while standing on one leg (a motion similar to the motion that happens during a one leg landing).
Now, while there are some conclusions about changes in mechanics from the above studies, they do not directly link ankle taping with subsequent knee/hip/low back injury. As such, I would like to argue that their findings were limited and do not necessarily represent the sports of gymnastics/acrobatics. If you'll hold the comments until the end, let's discuss -
- All were conducted on a treadmill or with a planned movement course. In the studies, they needed to control against individual variation in movement so the researchers created an artificial movement pattern (treadmill running/controlled lateral shifting). It's unlikely that you'd ever see a lateral ankle sprain on the treadmill so it's plausible that the forces encountered on the treadmill are also unlikely to affect the knee/hip either. Gymnastic take-offs and landings are not so precise or clear-cut and have a lateral component that can't be ignored.
- A good ankle tape completely limits the lateral motion at the joint (the side to side). When you achieve this, there is also some secondary loss of plantar flexion and dorsiflexion (the point and flex of the ankle). While some participants saw changes in energy demands to overcome that stiffness in the ankle taping during their movements, others did not. This means that some athletes' performance was more negatively impacted than others. This variability is an issue when training gymnastics. For example, if you're working with a gymnast that's learning a new skill or an athlete at the end of a 3-hour practice, it's likely that their energy demands are higher relative to the task. If their take off/run is impacted, the landing could be extremely variable (and we all know that poor/variable landings create higher injury risk).
- The loss of hip motion was universal in the studies, though the authors noted that the average of 3.18 degrees may be "trivial" in most cases. In a sport as precise as gymnastics, that loss in motion at the hip has to be compensated for in another joint. Any experienced coach will recognize that "3 degrees more" in the knee or low back when an athlete is already pushing the boundaries may not be possible. As such, it is understandable that such a change in mechanics at the ankle and hip might put the knee/low back at a higher risk for injury.
The listed studies suggest that in controlled activities, ankle bracing/taping doesn’t have much negative effect, except on hip mobility. As the researchers note, more information is needed on the effects of ankle wrapping in a more dynamic setting and I'd agree. As static/controlled motions aren't the ones injuring most gymnasts, there is much more research that needs to be done on this topic.
Check back for Part 2 & Part 3, where we will review:
- The biomechanics of each of the ankle, knee and hip joints relative to take-offs and landings.
- When and how to tape/brace to mitigate your risk of recurring ankle injury.
- Types of techniques
- Better braces for the sport
- How to protect the knee/hip/low back while you are taping/bracing - exercises and cues.
- How to retrain the ankle and ditch the tape so that the long-term prognosis is better.
- Callaghan MJ. Role of ankle taping and bracing in the athlete. Brit J Sports Med 1997;31(2):102-108.
- Kernozek T, Durall CJ, Friske A, Mussallem M. Ankle bracing, plantar-flexion angle, and ankle muscle latencies during inversion stress in healthy participants. J Athl Train 2008;43(1):37-43.
- Papadopoulus ES, Nicolopoulos C, Anderson EG, et al. The role of ankle bracing in injury prevention, athletic performance and neuromuscular control: a review of the literature. The Foot 2005;15(1):1-6
- Paulson, Sally; Braun, William A. Prophylactic Ankle Taping: Influence on Treadmill-Running Kinematics and Running Economy. Journal of Strength & Conditioning Research: February 2014 - Volume 28 - Issue 2 - p 423–429.
- Richard MD, Sherwood SM, Schulthies SS, Knight KL. Effects of tape and exercise on dynamic ankle inversion. J Athl Train 2000;35(1):31-37.2.Refshauge KM, Kilbreath SL, Raymond J. The effect of recurrent inversion sprain and taping on proprioception at the ankle. Med Sci Sports Exerc 2000;32(1):10-15.
- Stoffel, Karl & L Nicholls, Rochelle & Winata, Ruth & Dempsey, Alasdair & J W Boyle, Jeffrey & Lloyd, David. (2010). Effect of Ankle Taping on Knee and Ankle Joint Biomechanics in Sporting Tasks. Medicine and science in sports and exercise. 42. 2089-97.